Charles Hodge, a medical doctor and biblical counselor, considers the matter of depression and bipolar disorder. In the first five chapters, he surveys the medical literature to argue there has been a massive over diagnosis of “depression” — not because the persons who present to the physician do not meet the DSM criteria [but even here there is a problem, because 25% of psychiatrists and 50% of general practitioners admit that they do not use the DSM IV criteria in making a diagnosis], but rather that the criteria capture too many false positives: the criteria do not distinguish between “normal” and “disordered” sadness.
“‘Normal sadness’ is something that happens to most of us when we lose something very important to us” (62). Such sadness will correspond to the nature of the loss and will alleviate when the trouble has been removed. Relying on the work of Horwitz and Wakefield, Hodge draws the correlation between 90% of the patients who show no benefit over a placebo for “depression” treatment and those who apparently are just sad and not “depressed”:
If the estimate is correct and 90 percent of those diagnosed with depression are simply sad because of a significant loss, it may also be that they are the 90 percent of patients for whom current medication is no more effective than a placebo. (68-69)
What of the other 10 percent:
I am often asked if I believe that the 10 percent with explained sadness represent a disease. The answer is: I do’t know. Nor does anyone else. No one in medicine, psychology, or biblical counseling should surrender to the argument that prolonged unexplained sadness is a disease. We should want a better explanation ….Until we have a pathological explanation for the 10 percent, we should be willing to say, “I don’t know.” (71)
Hodge then proceeds to discuss the ways in which sadness can produce good results. He first looks at the general research on the ways in which sadness can do good a person following a loss. He next looks at sadness in light of how the Scripture discusses sadness and hope. He discusses sadness in light of one’s desire and loss of expectation — and then the motive of one who has experienced such loss. I will not try to summarize his argument and the points of counseling (buy the book). However, I can provide the matrix in which he discusses sadness and loss:
[T]rouble and sorrow have great value when we pursue it guided by 2 Corinthians 7:10 [For godly grief produces a repentance [a change of thinking and living] that leads to salvation without regret, whereas worldly grief produces death.] When we choose to see sorrow the way God intends [as means and catalyst for transformation] we do not sorrow as those who have no hope. Godly sorrow leads to changes in our mind’s perspective and our heart’s priorities. The sorrow of the world often leads to deadly detours in living. (155).
The final chapters deal with bipolar disorder. In these chapters he carefully distinguishes between bipolar I (the old manic depressive) which plainly appears to be a medical condition, and bipolar II which has a much broader diagnostic criteria and may often be the result of side effects from (unnecessary) anti-depression medication.
The book ends with an appendix on the Gospel and another appendix on diseases which cause depression/depressive symptoms.
Recommendation: Buy it, read it.